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Comment: How cutting-edge femtech can remove the barriers to IVF and close the fertility gap

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Hans Gangeskar, CEO of Overture Life, on harnessing lab automation to make IVF more accessible.

As infertility rates continue to rise globally, in vitro fertilisation (IVF) is an increasingly critical aspect of women’s health and reproductive freedom.

The promise that women should be able to choose when and if to have a baby remains unfulfilled without radical technological advances in IVF both to improve outcomes and to reduce prices. At current costs and success rates, IVF remains out of reach for most women due to cost and emotional burden.

IVF has recently reentered the political arena in the US, where most women must pay out of pocket for an IVF cycle can cost in excess of $20,000 (£15,800), and on average it takes 2.5 cycles to have a baby, driving the average cost of an IVF baby to around $50,000 (£39,500).

This is obviously out of reach in most cases. The conversation has centered around better insurance coverage, but that cannot address the underlying lack of capacity. IVF is supply constrained because there are not enough IVF clinics and embryology labs to meet current demand.

Overture Life CEO Hans Gangeskar

The key to expanding access, in the US and globally, is to bring down the cost of each cycle, and drastically reduce the number of cycles necessary.

We need the opposite of the development we have seen in the rest of healthcare, where the price of services increases much faster than inflation.

Driving prices down and quality up to make IVF affordable requires new technology, standardisation and automation.

The costs of infertility and IVF are not just financial, and for many couples the burden of a failed cycle and the stress of the high financial burden combine to reach a threshold where they give up.

Researchers and experts around the world continue to tell us why fertility rates are dropping. Reasons cited range from expense of child rearing, forever chemicals, diseases like cancer and long covid and more.

It is however very clear to us that the time when women want to have children has changed, and this is an area where technology can come in and deliver more reproductive freedom to address fertility obstacles head-on.

Globally, only a fraction of fertility service demand is met, and new technology must deliver lower costs but also better results. Even successful IVF generally takes multiple attempts, with attendant stresses on physical and mental health – 80% of IVF patients report symptoms of clinical depression.

Cutting-edge femtech has the ability to address the fertility gap in novel ways, especially by modernising and miniaturising the embryology lab.

Shrinking costs

One of the main drivers of the high price tag is embryology laboratory expenses, which can account for half of all IVF costs, limiting access in several ways. First, many procedures done today are still manual, resembling ones used 45 years ago. This limits viability rates, driving up the number of cycles needed for a successful IVF.

It also means the procedures remain complex, requiring highly trained staff who are in high demand. This in turn helps make it cost-prohibitive for small facilities to fully staff an embryology lab, thereby capping availability – and over 5 million women in the UK now have limited or no access to local fertility clinics.

Bringing IVF costs down is primarily a question of opening more points of care. We need to make it possible to offer IVF services alongside other medical services making it economically viable to serve only 100 IVF cycles per year, or even as low as 20.

Technology is beginning to enable this potential. In addition, the promise of automation is not just efficiency, it is the ability to standardise and iterate. And this isn’t just the ability to standardize across an industry, but to standardize between shifts in a single clinic.

IVF clinics have pioneered many advances in the field, but it is also a very manual and artisanal practice, making it hard to copy processes from one embryologist to another, let alone from one clinic to the next.

Automated technology helps standardise steps like egg freezing, intracytoplasmic sperm injection (ICSI), and embryo selection, which are prone to human error.

Together, these platforms have been shown to improve viability rates meaningfully – a huge cost savings for patients. It can also shrink the required overhead for a small facility by an order of magnitude, further lowering costs while expanding access.

An automated world

Bringing IVF services to fertility deserts first and foremost requires portability. Microfluidics, a technology popularised in medtech to bring complex processes closer to the point of care, is important for both shrinking and automating vitrification – the freezing and thawing of eggs and embryos.

Because it is a more gentle way of handling cells (eggs), microfluidics reduces osmotic stress on fragile cells, minimising egg and embryo loss. It also enables small, powerful automated devices.

Robotics is also key for any automation paradigm, generally reducing both handling time and process complexity. There is a prime opportunity for improvement when making an embryo, the most challenging task in an embryology lab.

Technology is now in use that can automate the technique known as Piezo-ICSI, a gentle and precise method to inject sperm into an egg that improves both fertilisation and blastocyst development.

Robotic ICSI has already resulted in two live births and has been shown to increase fertilisation rates to 93 per cent, compared to 89 per cent for manual methods.

Of course, the consistency of robotics also removes the potential for human variability and error, removing the potential for fatigue.

Anecdotally, some IVF clinics have noted lower success rates when complex manual procedures are performed by embryologists late in the day.

A robotic platform can also reduce inconsistency between embryologists and between labs, which translate into more consistent, better outcomes.

The third critical piece for automation excellence is advanced analytics, especially when paired with AI techniques. Technology has been deployed to improve on standard preimplantation genetic testing (PGT), which helps identify and select embryos without genetic disease.

However, standard PGT predicts embryo implantation at just 60%, leaving plenty of room for improvement. It also relies on a biopsy to remove cells from the embryo, which carries a small risk of damaging it.

Newer methods utilize metabolomics powered by machine learning. These platforms have been shown to improve implantation prediction accuracy above 80%, and can identify and discard 90% of aneuploid embryos (with chromosomal abnormalities). Because only metabolites produced by the embryo, no invasive biopsy is required, reducing the demand on embryologists while helping to identify stronger embryos.

Given the significant and growing fertility challenges around the world, and the notable gaps in access to treatment driven by cost and geography, it’s clear that we in the fertility field need to do a better job of reaching women everywhere. Because labwork is not patient-facing, its impact can be broadly underestimated or even ignored.

However, the reality is that there are multiple opportunities to improve the embryology lab through automation, improving outcomes and ensuring embryologists can spend more time with more patients.

Hans Gangeskar is CEO of Overture Life, which aims to simplify and automate the complex processes of embryology.

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UK reviews surrogacy firm over rejected insurance claims

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The UK government is reviewing a surrogacy firm after complaints that medical insurance claims involving surrogates in Mexico were rejected.

The Department of Health and Social Care (DHSC) is considering whether UK-based provider My Surrogacy Journey should remain listed on gov.uk as one of four domestic surrogacy agencies available to intended parents.

The review follows allegations concerning its Mexican sister company, where surrogates are based.

Health minister Diana Johnson said: “The department is looking into the allegations about My Surrogacy Journey.

“As part of that assessment, the department will consider whether it is appropriate for that company to remain on the gov.uk list of agencies.”

Emails sent by My Surrogacy Journey chief executive Michael Johnson-Ellis and seen by the Guardian suggest multiple surrogate women in Mexico had their insurance claims rejected.

The emails also suggest 300 couples using the company were moved to a new insurance provider because of the increased risk of claims being rejected.

Commercial surrogacy is banned in the UK, where only altruistic arrangements are permitted.

My Surrogacy Journey operates a not-for-profit UK branch alongside for-profit sister companies in Mexico and the US. All three companies have the same owners and chief executives.

The reported insurance issues relate to surrogacy arrangements in Mexico.

One couple told the Guardian they paid tens of thousands of pounds to cover medical costs after their surrogate had a hysterectomy during childbirth and an insurance claim was refused.

The Guardian said it understood that at least five sets of parents said they had to cover medical costs after insurance claims were rejected.

In an email to the couple whose surrogate underwent a hysterectomy, Johnson-Ellis wrote: “We have already told you that the insurance companies have been declining some of the claims and we are actively working with the broker to get this issue resolved but you should also consider that they may not be paid out and there is nothing we are able to do to change this …

“We appreciate this is not an insignificant sum but this genuinely is out of our control.”

Johnson-Ellis also said the company had switched insurance providers, writing: “We’re also managing this for 300 other journeys, which is a complex position to be in.”

Lawyers acting for My Surrogacy Journey said the company did not comment on individual cases, but that existing insurance policies were in place and claims continued to be accepted and processed.

They said the company understood that a small number of claims had been rejected and was supporting people seeking to resolve those claims with an insurer.

Under the surrogacy arrangements, intended parents are understood to be contractually required to cover medical costs not paid by an insurer.

The couple said they had been recommended the company’s Mexico option. Its website advertises that intended parents using the route can have a baby in “under 18 months”.

They said they were told the UK route could take up to five years and that the US option was much more expensive.

Lawyers for My Surrogacy Journey said prospective parents are given information about typical timelines, costs, legal frameworks and practical considerations, and that the 18-month timeframe is indicative only.

The couple said their surrogate developed placenta accreta, a serious condition in which the placenta attaches to the wall of the uterus.

Emails from Johnson-Ellis acknowledged that the insurance provider investigated the birth after the surrogate experienced health complications.

The parents are considering legal action, while the Guardian said it understood at least four other couples were reviewing their options.

Phil Brickell, MP for Bolton West, raised concerns in parliament about a separate couple who had used My Surrogacy Journey.

He said: “Two of my constituents recently travelled to Mexico, where their children were born by surrogacy.

“Those births were facilitated by a company called My Surrogacy Journey, which is listed on gov.uk.

“While in Mexico, they had repeated traumatic experiences with the company relating to issues including insurance for their children, accusations of bullying towards staff and repeated efforts to silence any constructive criticism.

“I understand that other members of this house have received similar complaints.”

Brickell called for My Surrogacy Journey to be removed from gov.uk pending a review by the Human Fertilisation and Embryology Authority.

Lawyers acting for My Surrogacy Journey said the company was communicating with DHSC and was confident any issues could be resolved.

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‘Limited scientific evidence’ for most menopause supplements, expert says

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Many menopause supplements contain ingredients with limited evidence for symptom relief, while formulations and prices vary widely, a study has found.

Researchers analysed 201 products sold by nine major UK retailers, comparing their ingredients, doses and monthly costs.

Prices ranged from £1.50 to £95 a month, while no single ingredient or category of ingredient was common across all products.

The study, carried out by University College London, found that 80 per cent of products contained herbs, 77 per cent contained vitamins and 74 per cent contained phytoestrogens, naturally occurring plant compounds found in foods including soy and flaxseed.

Vitamin B6 was the most common vitamin, while red clover and sage were the most frequently identified plant ingredients.

Researchers said more evidence was needed on the effectiveness and safety of supplements marketed for menopause symptoms.

Professor Joyce Harper, senior author of the study and professor of reproductive science at University College London, said: “The menopause supplement market is growing rapidly, despite limited scientific evidence that many of these products improve menopause symptoms.

“Some social media influencers promote these products as effective solutions, despite many claims not being supported by scientific evidence.

“This can contribute to the spread of misinformation and help drive a rapidly growing menopause supplement market, leading some women to spend substantial amounts of money on supplements in the hope of improving their symptoms and overall wellbeing.”

Half of the supplements did not contain vitamin D, while less than 24 per cent contained calcium.

The British Menopause Society and International Menopause Society have highlighted vitamin D and calcium as important for maintaining bone health and preventing osteoporosis after menopause.

Researchers also identified botanical ingredients that may carry risks, including black cohosh.

Poppy Sullivan, first author of the study, said: “Certain botanical ingredients in some menopause supplements may also have risks.

“Black cohosh, in particular, is known to carry a potential risk of liver toxicity.”

The amounts of vitamins and minerals included in different products also varied widely.

Sullivan said: “Some nutrients can have adverse effects when consumed in excess over time.

“For example, excessive vitamin D intake can theoretically lead to high calcium levels, which could cause adverse effects such as vomiting and confusion.”

The study found little empirical evidence supporting the effectiveness of even the most expensive products.

Researchers called for more high-quality research, including clinical trials, to determine whether menopause supplement ingredients are effective and safe.

They said the findings could also help healthcare professionals understand the wide variation in supplement formulations.

The researchers acknowledged that the analysis may not have included every menopause supplement available in the UK.

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Ultrasound Direct extends Trice Imaging partnership

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Ultrasound Direct has extended its Trice Imaging partnership for three years, adding a reporting tool across its 70-clinic UK network.

The private ultrasound provider will continue using the Tricefy platform for secure image storage and patient engagement, alongside TriceIQ for efficiency and productivity analytics.

It will also introduce Trice Workspace Reporting across its network. The companies say the tool will help standardise ultrasound reporting templates and workflows and reduce variation between clinics.

Ultrasound Direct carries out an estimated 120,000 patient scans each year across services including pregnancy, fertility, women’s health, men’s health and other diagnostic pathways.

Its network uses a large pool of sonographers working across different ultrasound systems and serves referral routes including self-referring patients, GPs and commercial partners.

Mike Steward, founding director at Ultrasound Direct, said: “Having worked with Trice Imaging since 2018, we first partnered to replace manual methods of providing scan images to expectant parents with Trice’s secure electronic image-sharing platform. Today, every study performed across the Ultrasound Direct Network is recorded and stored on Tricefy, while our clinical services have expanded considerably beyond pregnancy into fertility, women’s health, men’s health and other diagnostic pathways.”

He added: “To continue futureproofing our image management strategy across a network of 70 clinics, a large team of sonographers, varying ultrasound systems and a growing number of referral partners with different needs, we decided to extend with Trice Imaging. This includes the introduction of the new Trice Workspace Reporting module to help us scale and standardise our ultrasound reporting templates and workflow, reducing variability between clinics.”

The partnership began in 2018, initially focusing on replacing manual methods of sharing pregnancy scan images with expectant parents.

Johanna Wollert Melin, founder and chief executive of Trice Imaging Europe, said: “Ultrasound Direct has been a valued partner in the UK for 8 years.”

She added: “At the heart of the relationship is a willingness to explore new ideas, test new tools and the spirit to solve real challenges across a large and complex clinical network.”

Mark A. Samii, chief revenue officer at Trice Imaging, said: “We are delighted to retain and extend our relationship with Ultrasound Direct.”

He added: “The addition of Trice Workspace Reporting addresses a challenge we hear from multi-site providers globally – keeping reporting quality consistent across many users, systems, referral or payer relationships.”

Steward said Ultrasound Direct continues to see growing demand for private diagnostics alongside NHS care from self-referring patients and an increasingly diverse range of professional and commercial referral partners.

He added: “As that development continues, scalable digital infrastructure becomes increasingly important. Our focus is on ensuring that a growing national network can support consistent clinical workflows, different referral pathways and the technology requirements of the future, while continuing to provide patients with accessible diagnostic services.”

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